Medicare and other funding sources that follow Medicare guidelines have long considered the “reasonable, useful lifetime” (RUL) of durable medical equipment to be five years. This means that these funding agencies will not pay for a piece of equipment to be replaced within five years of its purchase, unless a change in medical condition warrants the purchase of a new type of equipment.
Historically, this rule was not applied to wheelchair cushions and back supports. However, this changed recently when suppliers began seeing denials for replacement cushions and backs, if the existing equipment was purchased within the last five years.
The wheelchair seating industry does not believe that the five year “RUL” policy should be applied to wheelchair seating. We are working hard to advocate for this policy to be changed.
In the meantime, there are ways to “repair” Ride Designs’ cushions and back supports, and to have those repairs covered by insurance.
Components of existing Ride wheelchair cushions and backs can be ordered individually for replacement, and often this will resolve any issues that are causing the cushion or back to need replacement. For example, if a Ride Java® Cushion has compressed foam and is no longer providing proper positioning or skin protection, the foam topper can be replaced individually, without having to replace the entire cushion. This (and any other cushion or back components except covers) can be billed with code K0108. Labor to replace the component (E1340) can be billed to most payers as well, including Medicare. Replacement covers are billed using code E2619.
Please refer to the Ride Parts Manual to locate part numbers for individual cushion and back components, or contact our Customer Service Department at 303.781.1633 or firstname.lastname@example.org for more information.